Spleen tyrosine kinase inhibition is an effective treatment for established vasculitis in a pre-clinical model
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Published version
Author(s)
Type
Journal Article
Abstract
The anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitides (AAV) are a group of life-threatening multi-system diseases characterized by necrotising inflammation of small blood vessels and crescentic glomerulonephritis. ANCA are thought to play a direct pathogenic role. Previous studies have shown that spleen tyrosine kinase (SYK) is phosphorylated during ANCA-induced neutrophil activation in vitro. However, the role of SKY in vivo is unknown. Here, we studied its role in the pathogenesis of experimental autoimmune vasculitis, a pre-clinical model of myeloperoxidase-ANCA-induced pauci-immune systemic vasculitis in the Wistar Kyoto rat. Up-regulation of SYK expression in inflamed renal and pulmonary tissue during early autoimmune vasculitis was confirmed by immunohistochemical and transcript analysis. R406, the active metabolite of fostamatinib, a small molecule kinase inhibitor with high selectivity for SYK, inhibited ANCA-induced pro-inflammatory responses in rat leucocytes in vitro. In an in vivo study, treatment with fostamatinib for 14 days after disease onset resulted in rapid resolution of urinary abnormalities, significantly improved renal and pulmonary pathology, and preserved renal function. Short-term exposure to fostamatinib did not significantly affect circulating myeloperoxidase-ANCA levels, suggesting inhibition of ANCA-induced inflammatory mechanisms in vivo. Finally, SYK expression was demonstrated within inflammatory glomerular lesions in ANCA-associated glomerulonephritis in patients, particularly within CD68+ve monocytes/macrophages. Thus, our data indicate that SYK inhibition warrants clinical investigation in the treatment of AAV.
Date Issued
2020-06-01
Date Acceptance
2019-12-13
Citation
Kidney International, 2020, 97 (6), pp.1196-1207
ISSN
0085-2538
Publisher
Elsevier
Start Page
1196
End Page
1207
Journal / Book Title
Kidney International
Volume
97
Issue
6
Copyright Statement
© 2020 Published by Elsevier, Inc., on behalf of the International Society of Nephrology. This version is available open access under a CC-BY Licence (https://creativecommons.org/licenses/by/4.0/)
Sponsor
Vasculitis UK
The Academy of Medical Sciences
Medical Research Council (MRC)
Wellcome Trust
Medical Research Council (MRC)
Imperial College Healthcare NHS Trust
Grant Number
ID 1503
N/A
MR/M018733/1
097882/Z/11/ZR
G0901997
FR420
Subjects
ANCA
SYK
experimental models
glomerulonephritis
kinase inhibitors
vasculitis
Urology & Nephrology
1103 Clinical Sciences
Publication Status
Published
Date Publish Online
2020-01-16